Project Summary The Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) study is a two- phase (UG3 & UH3), multi-method study to implement community action teams and a peer rural care coordinator intervention in rural Oregon counties at high risk for opioid overdose, hepatitis C, and HIV. The study leverages existing and developing public health and treatment infrastructure to implement a sustainable rural peer care coordinator (PCC) model. In Phase 1 (UG3), we develop community action teams that review and develop local community response plans to address OUD and its consequences in 2 high-needs rural counties. Focus groups and qualitative interviews with community stakeholders (primary care providers, public health officials, law enforcement, and affected community members) document needs, resources, and identify best practices for response plan implementation. We also assess the feasibility of a PCC intervention to improve HIV, hepatitis C testing and linkage to care for people with OUD, and sending confirmatory phlebotomy to CDC/GHOST lab. A concomitant telehealth intervention supports primary care providers in treatment of patients with OUD and hepatitis C. Phase 1 (UG3) milestones include: 1) development of community response plans, 2) enrollment of primary care providers in telehealth support, 3) pilot implementation of PCC intervention, and 4) participant phlebotomy samples successfully sent to CDC/GHOST lab. In Phase 2, we scale- up the PCC intervention to 8 rural counties to assess the effectiveness of PCCs in improving HIV and hepatitis C testing, opioid overdose, and linkage to treatment for HIV, hepatitis C, and opioid use disorder. The step-wedge implementation design includes counties not yet initiating the intervention to serve as temporal controls. The primary outcome is 1) number of HIV tests performed in intervention versus non-intervention counties. Secondary outcomes include a) overdose rates, b) initiation of HIV treatment, c) initiation of HCV treatment, d) initiation of OUD treatment, e) HIV viral suppression at one year, and f) hepatitis C sustained viral response. Continued qualitative stakeholder interviews in Phase 2 document challenges and best practices for PCC intervention and community response plan implementation. The results inform development of novel and sustainable community intervention models to decrease OUD and its consequences in rural America. The proposed work aligns with NIH Office of AIDS Research priorities of expanding HIV testing and engagement in treatment, and treatment of HIV comorbidities.